The opinion of the court was delivered by: Morrison C. England, Jr. United States District Judge
Through this action, Plaintiff Gwendolyn Creer ("Plaintiff") challenges the denial of disability benefits payable under a benefit plan established by her employer, AT&T. That plan, known as AT&T Umbrella Benefit Plan No. 1, is an employee benefit plan subject to the provisions of the employee Retirement Security Retirement Act, 29 U.S.C. §§ 1001, et seq. ("ERISA"), and is being sued directly by Plaintiff in the instant matter. Both Plaintiff and the AT&T Umbrella Benefit Plan No. 1 ("Defendant Plan") have now moved for summary judgment.
As set forth below, the summary judgment requests are premature because the investigation required to make an accurate disability assessment by Defendant Plan with respect to the payment of benefits has not yet occurred. The cross-motions for summary judgment will be denied, without prejudice, on that basis and the matter remanded for further proceedings consistent with this Memorandum and Order.*fn1
Plaintiff worked for AT&T as a circuit designer for 21 years between 1985 and 2006. In that position, her job duties were primarily sedentary in nature, involving computer and telephone use. In early 2005, after being diagnosed with disseminated sarcoidosis (a kind of tissue inflammation) affecting the liver and spleen, Plaintiff was approved by Defendant Plan for short term disability ("STD") and remained on STD status until October 31, 2005.
After attempting to return to full time work status in November of 2005, Plaintiff was again approved for STD based not only on sarcoidosis, but also due to liver complications, diabetes and high blood pressure. Plaintiff thereafter remained on STD status until June of 2006.
According to Plaintiff, she has to take more than 20 medications per day to manage her various symptoms, and achieving the correct balance of those medications is difficult since some drugs designed to alleviate one condition make others worse.
Plaintiff again tried to return to work on July 10, 2006, but by September 8, 2006 decided she was no longer able to do so because of difficulty sleeping, ongoing headaches and hard to control diabetes. Thereafter, on or about October 2, 2006, Defendant Plan denied Plaintiff her remaining STD benefits (which amounted to only five days), and by disallowing those benefits also deprived plaintiff of the opportunity to qualify for long term disability benefits ("LTD"), since Defendant Plan required, as a prerequisite to qualifying for LTD, that Plaintiff exhaust the full 52 weeks of available STD benefits.
By letter dated October 6, 2006, Plaintiff's treating doctor, Rachel Callaghan, strongly objected to Defendant's denial, explaining that the sarcoidosis had to be treated with Prednisone, a medication which both worsened Plaintiff's diabetes and also compounded the fatigue caused by sarcoidosis. Plaintiff thereafter appealed.
Pursuant to a Service Agreement, Defendant Plan alleges it delegated the entire claims review process to an independent company, Sedgwick Management Services. According to Defendant, Sedgwick was given full and complete discretion by the Plan Administrator in processing disability benefit claims. Decl. of Nancy Watts, ¶ 7.
Following Plaintiff's January 16, 2007 appeal, Sedgwick had an outside vendor, National Medical Review, obtain review of Plaintiff's medical records from three different specialists in the practice areas invoked by Plaintiff's various conditions. While all three reviewing physicians opined that Plaintiff was in fact able to perform the relatively sedentary duties of her position, each reviewer carefully limited the scope of his review to his own area of expertise and failed to assess either the gravity of Plaintiff's medical conditions, taken as a whole, or what Plaintiff alleges was her most serious single condition, sarcoidosis.
Dr. Lyle Mitzner, an endocrinologist, appears to only comment on Plaintiff's diabetes, concluding that "there is no indication that her diabetes, per se, is preventing her from functioning at work." Administrative Record ("AR") 0498.
Dr. Mitzner carefully delineates the limited nature of his review and the fact that it addresses neither Plaintiff's condition as a whole or her sarcoidosis, stating as follows:
I have been asked as an endocrinologist to review these records. An internist and a pulmologist will be reviewing this and commenting on her overall medical condition and her sarcoidosis, respectively..... Whereas the constellation of her symptoms together and her multiple medical conditions together may indeed make it difficult or even impossible, I am going to leave that decision to the other doctors reviewing this file. AR 0497.
Despite Dr. Mitzner's indication that an internist would comment on the effect of Plaintiff's condition taken as a whole, the retained internal medicine specialist, Dr. Jose A. Perez, Jr., declines to make any such overall assessment, stating as follows:
I will defer to the pulmonoligist and endocrinologist reviewing this file to make a determination on the sarcoid and the type II diabetes mellitus both of which appear to be complicated disorders and related in that the treatment for the sarcoidosis affected the control of type II ...